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Audit: State program designed to stop "doctor shopping" is not as effective as intended

PDMP created to electronically track and monitor prescriptions
Audit: State program meant to stop "doctor shopping" is not as effective as intended
Posted at 11:20 AM, Jul 22, 2021
and last updated 2021-07-22 13:21:56-04

SOUTHERN COLORADO — Doctor shopping is a strategy used to get more prescription drugs, by visiting a variety of doctors or pharmacies. A recent Colorado state audit found the program meant to stop doctor shopping is not operating as effectively as it could.

The Prescription Drug Monitoring Program (PDMP) was enacted in 2008 "to electronically track and monitor prescriptions to help prevent their misuse, allow prescribers to review their patients’ prescription histories, and help law enforcement and regulatory boards investigate potentially harmful prescribers," according to the audit.

Since 2014, Colorado pharmacists have been required to submit their data on dispensed controlled substances to the PDMP database. However, the audit claims "most pharmacies did not submit prescription data to the PDMP within one business day, as rules require. Colorado pharmacies submitted about 5.5 million prescriptions (35 percent) an average of six business days late." The Office of the State Auditor says that makes the PDMP database less accurate.

Other key findings from the audit include:

  • Since the PDMP has been in place, recorded overdose deaths from prescription opioids rose significantly in Colorado, from 246 deaths in 2008 to 433 deaths in 2019.
  • In 2018 and 2019, PDMP data showed 8,700 patients in Colorado with prescription histories that indicated doctor shopping for opioids because they each received one or more opioid prescriptions from 10 or more prescribers, which is nearly 10 times the average. For example, 20 patients got an average of 73 opioid prescriptions from at least 25 different doctors and 10 different pharmacies. Yet, the PDMP does not refer such patients to law enforcement.
  • The State does not use PDMP data to identify and address overprescribing, although PDMP data showed 85 Colorado medical professionals who each prescribed more than 3,000 opioids in Calendar Years 2018 and 2019, which was 26 times the number of opioids as the average prescriber. Most of the 85 prescribers were in family medicine, internal medicine, and nurse practitioners, and their prescribing trends indicate “pill mills,” or the prescribing of more opioids than patients need.
  • 18 percent of Colorado’s 34,679 prescribers were not registered to use the PDMP database, as statute requires, which may hamper their ability to provide quality care and ensure patients receive safe amounts of opioids. The PDMP also does not track whether prescribers query the database before issuing a second opioid prescription to a patient, as statute requires, so it is unclear whether prescribers comply.
"As shocking as those are, those numbers used to be way higher when the PDMP started. We used to see thousands of those."
Dr. Robert Valuck

CLICK HERE to read the full audit of Colorado's PDMP.

The audit had a handful of recommendations for the PDMP, which are as follows:

  • Improve the effectiveness of the PDMP by working with the General Assembly on statutory changes that would require prescribers to query the PDMP database before prescribing each opioid.
  • Enforce the requirements that prescribers and pharmacists register to use and query the PDMP database.
  • Enforce statutory limits on opioid prescriptions and develop enforcement mechanisms for noncompliant prescribers.
  • Ensure pharmacies comply with rules to timely submit data on prescriptions to the PDMP database.

The PDMP is within the Department of Regulatory Agencies (DORA) for the state. A spokesperson for DORA told News5 they have agreed to all of the recommendations made in the audit. DORA will go before the Legislative Audit Committee to give an update on the recommendations at a status hearing in around five months.

In implementing the state audit recommendations, the Department (DORA) looks forward to working with the General Assembly and focusing on improving the effectiveness of the program, which may include requiring prescribers to check the PDMP before prescribing each opioid and at least before prescribing each benzodiazepine, to provide authority to the Department to develop criteria to identify patients that appear to be doctor shopping and to refer those patients to law enforcement and the appropriate healthcare board(s), as well as otherwise set forth in the responses in the audit report.
Spokesperson, DORA

Dr. Robert Valuck is the Executive Director of the Center for Prescription Drug Abuse and Prevention. He says one of the recommendations from the audit was already addressed during the legislative session. A Colorado House of Representatives bill, called the Prevention of Substance Use Disorders, was signed by Governor Jared Polis at the end of June. It requires doctors check the PDMP database on the first prescriptions of opioids or benzodiazepines. "We push doctors to prescribe the fewest amount possible. We push patients to dispose of the leftovers, don't leave them lying around. That's like leaving a loaded gun on the counter, and wondering why someone got shot with a loaded gun on the counter," said Dr. Valuck.

Dr. Valuck said many of the large health care systems already use the PDMP database as part of their practice. However, he said for smaller facilities that do not have the PDMP integrated into their system, it can take a fair amount of time for doctors to use the tool. "On average it takes them four or five minutes to go over and log into the PDMP, and check it, and put in the patient info, and return the report... That's a third of their visit. They don't have time to spend a third of their visit looking up a piece of information that is only useful maybe one percent of the time... The intent of the law is good, the intent of the PDMP is good, the utility of the information is very good. Nobody disagrees with any of that. Where the doctors disagree is, logistically, I can't do what you're asking me to do," explained Dr. Valuck.

Dr. Valuck said there is work being done to make using the PDMP database easier for doctors. He would like to start a grant program to integrate the PDMP into all doctor's systems, and he expects to see that begin happening over the course of around one or two years.

Dr. Valuck said he does not believe it is possible to link the PDMP to an increase in overdose deaths. "It's a piece of a very complicated puzzle," said Dr. Valuck.

Ashley Parsons, who lives in Pueblo, said her addiction began in a doctor's office. She was prescribed "monstrous" doses of opioids like oxycontin or dilaudid. The first time she ran out, Parsons said the spiral of addiction started. "It seemed like overnight I went to my usual sources, and there was none available, but heroin was everywhere," said Parsons.

Parsons also said she would partake in doctor shopping as a way to obtain more pills.

Parsons has been in recovery for over two years. She started her own recovery program called HOPES as a way to help others who are struggling.